Foreword xvii
Acknowledgements xviii
List of contributors xix
Quick reference to the procedure guidelines xxiii
How to use your manual xxv
About the companion website xxviii
1 The context of nursing 1
Overview 2
Background 2
Context of nursing 2
Evidence-based practice 7
Structure of the manual 9
Structure of the chapters 9
Finally 9
References 10
Part One Managing the patient journey 13
2 Admissions and assessment 15
Overview 16
Inpatient assessment and the process of care 16
Observation 24
Physical assessment 25
References 44
3 Discharge care and planning 47
Overview 48
Discharge care and planning 48
Discharging patients from hospital: internal procedures 49
Interface between primary and secondary care: external processes 56
Informal carers 62
The role of voluntary services 65
References 66
4 Infection prevention and control 69
Overview 70
Infection prevention and control 70
Hand hygiene 80
Personal protective equipment (PPE) 92
Specific patient-related procedures 107
Isolation procedures 111
Environmental hygiene and the management of waste in the healthcare environment 118
Prevention and management of inoculation injury 125
References 126
Part Two Supporting patients with human functioning 131
5 Communication, psychological wellbeing and safeguarding 133
Overview 134
Communication 134
Providing information and making shared decisions 147
Communicating with specific populations 151
Psychological wellbeing 157
Safeguarding, mental capacity and the Mental Health Act 180
References 199
6 Elimination 205
Overview 206
Normal elimination 206
Altered urinary elimination 212
Altered faecal elimination 243
Stoma care 264
References 277
7 Moving and positioning 283
Overview 284
Moving and positioning: general principles 284
Moving and positioning an unconscious patient 297
Moving and positioning a patient with an artificial airway 299
Moving and positioning a patient with respiratory compromise 303
Moving and positioning a patient with neurological impairment 307
Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury 320
Moving and positioning a patient with raised intracranial pressure 330
Moving and positioning a patient with an amputation 331
References 336
8 Nutrition and fluid balance 339
Overview 340
Fluid balance 340
Nutritional status 357
Provision of nutritional support: Oral 365
Nutritional management of patients with dysphagia 371
Enteral tube feeding 372
Parenteral nutrition 395
References 398
9 Patient comfort and supporting personal hygiene 403
Overview 404
Personal hygiene 404
Sleep promotion in a hospitalized patient 416
Patient environment 418
Eye care 423
Ear care 433
Mouth care 437
References 450
10 Pain assessment and management 457
Overview 458
Pain 458
Pain management 467
Regional analgesia: local anaesthetic nerve blocks and infusions 473
Epidural analgesia 475
Entonox administration 485
Non-pharmacological methods of managing pain 489
References 492
11 Symptom control and care towards the end of life 497
Overview 498
End-of-life care 498
Symptom control 516
Terminal sedation 527
Care after death (last offices) 528
References 535
12 Respiratory care, CPR and blood transfusion 539
Overview 540
Respiratory therapy 540
Oxygen therapy 543
High-flow oxygen via a nasal cannula 552
Humidification 555
Non-invasive ventilation 556
Chest drain management 564
Tracheostomy and laryngectomy care 581
Basic life support 612
Transfusion of blood and blood components 626
References 650
Part Three Supporting patients through the diagnostic process 657
13 Diagnostic tests 659
Overview 660
Diagnostic tests 660
Blood sampling 664
Venepuncture: obtaining blood samples from a peripheral vein 667
Blood cultures 677
Cerebrospinal fluid obtained by lumbar puncture 679
Specimen collection: swab sampling 683
Specimen collection: urine sampling 692
Specimen collection: faecal sampling 698
Specimen collection: respiratory tract secretion sampling 700
Specimen collection: pleural fluid 702
Endoscopic investigations 702
Liver biopsy 708
Radiological investigations: X-ray 710
Magnetic resonance imaging (MRI) 710
Computed tomography (CT) 712
References 714
14 Observations 719
Overview 720
Observations 720
Pulse (heart rate) 723
Electrocardiogram (ECG) 730
Blood pressure 738
Respiration and pulse oximetry 745
Peak flow 757
Temperature 762
Urinalysis 768
Blood glucose 773
Neurological observations 781
References 796
Part Four Supporting patients through treatment 801
15 Medicines optimization: ensuring quality and safety 803
Overview 804
Medicines management 804
Self-administration of medicines 817
Controlled drugs 817
Routes of administration 827
Parenteral administration (injections and infusions) 854
Peripheral cannulas 898
Infiltration and extravasation 915
References 927
16 Perioperative care 937
Overview 938
Pre-operative care 938
Intraoperative care 973
Post-operative care 999
References 1022
17 Wound management 1029
Overview 1030
Wounds 1030
Pressure ulcers 1043
Surgical wounds 1053
Negative pressure wound therapy 1055
References 1058
Part Five Looking after ourselves so we can support patients 1061
18 Self-care and wellbeing 1063
Overview 1064
Self-care and wellbeing 1064
Mindfulness 1072
Eating and drinking 1073
Physical wellbeing and musculoskeletal health 1077
References 1081
Appendix: Standards of Proficiency for Registered Nurses 1085
List of abbreviations 1089
Index 1093
